Application for Employment

Name (First/Middle/Last)

Social Security Number

Phone

Address (Street/City/State/Zip)

Are you eligible for employment in the US? If hired, you are required to submit proof of eligibility.

Yes

Are you over the age of 18? If no, hire is subject to verification that you are of minimum legal age.

Yes

Position(s) Applied For

Were you previously employed with us?

Yes

If yes, when?

If your application is considered favorable, on what date will you be available to start

Are there any other job-related experiences, skills, or qualifications that will be of special benefit in the job for which you are applying?

Employment History

List below your present and past employment, beginning with your most recent.

Name of Company

Address (Street/City/State/Zip)

From

Reason for Leaving

Name of Supervisor

Phone Number

Describe the work you did:

Name of Company

Address (Street/City/State/Zip)

From

Reason for Leaving

Name of Supervisor

Phone Number

Describe the work you did:

Name of Company

Address (Street/City/State/Zip)

From

Reason for Leaving

Name of Supervisor

Phone Number

Describe the work you did:

I permit Highway Equipment & Supply Co. to contact the employer(s) listed above regarding my prior work experience.

Education History

Name of High School

Year Completed

Diploma or Degree Obtained

Name of Secondary Education

Year Completed

Diploma or Degree Obtained

Please Read and Sign Below

The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not, and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at will and can be terminated by either party with or without notice at any time, for any or no reason. No one other than an officer of Highway Equipment & Supply Co. has any authority to enter any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by an officer.

Your Signature

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